Is prior authorization required to get my Medicaid patient a CGM?

Get answers to this common question here.

No! If your patient is a Medicaid Managed Care Plan member, prior authorization is not required so long as they receive a CGM through a pharmacy or a durable medical equipment (DME) provider.

Patients enrolled in Medicaid MyCare or Fee-for-Service plans may require prior authorization depending on the plan.

For additional information, see Ohio Administrative Code Rule 5160-10-36 DMEPOS: continuous glucose monitors >